Glimpses of a plan to slash spending on the state’s health care program for the poor emerged Wednesday, with preliminary ideas ranging from eliminating a discount prescription program for seniors to stricter eligibility requirements that would leave thousands without health care coverage.

The menu of options was outlined in documents obtained by the Tribune that show potential cuts by Gov. Pat Quinn. While plans remain fluid, the draft provides a look at what’s on the table as the Democratic governor prepares to formally unveil his ideas Thursday.

Quinn has said the Medicaid system could collapse next year if spending isn’t slashed by at least $2.7 billion in the budget year that beings July 1. A bipartisan group of lawmakers has been examining ways to reach that figure, but has only been able to reach a consensus on how to cut about half of the governor’s requested amount.

They’ve asked for more time to draft a complete proposal, but Quinn is itching to move forward in the face of a tight deadline. Lawmakers are scheduled to wrap up May 31, though the governor has warned he will keep them in Springfield through the summer if necessary.

“There’s not an agreement but… the governor wants to go forward and get something out to the public,” said Rep. Patti Bellock, a Hinsdale Republican who is part of the group charged with finding ways to cut Medicaid.

To lessen the need for some cuts, Quinn’s administration also has floated the idea of raising taxes on cigarettes by $1 a pack, which would raise about $700 million. Republicans oppose the idea and say more must be done to reduce spending.

“I don't want to go forward with revenue enhancements that the taxpayers are going to have to pay for until we feel that we have exhausted all reforms that we can discuss,” said Bellock, who noted that discussions are ongoing.

Sen. Heather Steans, a Chicago lawmaker negotiating on behalf of Senate Democrats, suggested the cigarette tax increase could be temporary. Steans cast doubt $2.7 billion in cuts can be achieved in one year, and said the concentration must be on “doing things that make sense” so cuts in one area don’t cause patients to seek out more expensive care elsewhere.

One program on the list for possible elimination is Illinois Cares Rx, which provides discount drug coverage for 180,000 low-income seniors and people with disabilities across Illinois.

Also under consideration is limiting eligibility for adults enrolled in the Family Care health insurance program, which charges small co-pays and monthly premiums for services ranging from doctor visits to dental care and prescription drugs. If guidelines are changed, more than 26,000 people would no longer qualify for coverage.

The governor also is considering a reduction in reimbursement rates to health care providers, a move Republican Sen. Dale Righter of Mattoon warned would hit hospitals the hardest.

“By doing that, you’re reducing access” to care, Righter said. He said he feared the rate cuts across different health-care services could total more than $670 million.

Other ideas include eliminating a number of so-called “optional” services the state provides that are not required by the federal government, including getting rid of group psychotherapy for some patients and no longer funding chiropractic visits for adults. Podiatric care would be restricted to patients diagnosed with diabetes, and new limits would be placed on how often a patient could receive things like new dentures and eyeglasses or have a wheelchair repaired.

Additional cost-saving proposals include beefing up efforts by the state to ensure people who no longer qualify for Medicaid aren’t receiving benefits, and more standardized measures of care that emphasize prevention. Other ideas include reviewing medicines a patient receives to make sure they are all needed and adding or increasing co-pays for certain services.

“It’s a work in progress, a very painful process,” said Rep. Sara Feigenholtz, D-Chicago. “But in order to strengthen the long-term integrity of the program that is needed by the most vulnerable people in the state, these are the measures that need to be taken to prevent the whole Medicaid system from total collapse.”